Silicosis: why African miners’ fight for compensation is a just one

Mining giants Anglo American South Africa and AngloGold Ashanti have agreed to pay R464 million to more than 4400 miners who contracted silicosis and TB from working on the their mines. The settlement follows 12 years of protracted litigation against Anglo American South Africa and four years of litigation against AngloGold. Health and Medicine editor Candice Bailey asked Professor Jill Murray to explain some of the basis of the case.

What is silicosis and what is its relationship to TB?

Silicosis is a disease that you get from inhaling silica dust, also known as quartz, the rock the gold dust is embedded in. Drilling the rock generates the dust which miners then breathe into their lungs. This eventually scars their lung tissue.

Breathing in silica dust also compromises a person’s immune system which increases the risk of developing TB. Not everyone who develops silicosis contracts TB but they are between four and five times more likely to get TB than someone who doesn’t have silicosis.

Silica dust can never be removed from the lungs so a person with silicosis has an increased risk of contracting TB for their entire lives, even well after they have left the mines.

Some of the highest TB rates in the world have been recorded in South African gold miners. The World Health Organisation’s definition of an epidemic is if a country has a TB rate of 250 cases for every 100,000 people. At its height the mining industry in 2007-08, South Africa recorded 4000 cases for every 100,000 mine workers. That reflected a combination of silica, HIV and living conditions.

South African gold miners still have rates of more than 1000 per 100,000 people. In the US and Cuba, the TB rate per 100,000 people is less than 20 cases.

What is the burden of these diseases on society?

Silicosis takes a long time to develop. On average, it takes up to 15 years before symptoms show. If you look at people who have left the mines or who were exposed for long periods, one in three have silicosis.

Most silicosis cases are ex-miners who have either retired, been retrenched or lost their jobs because of injury or disease. Silicosis is not contagious but TB is. This means a person suffering from silicosis who contracts TB, is ill and needs care is a big risk to their family and to the population around them. It then becomes a problem for the entire society.

The burden of silicosis and tuberculosis associated with silica dust is being borne, not by the industry which caused the problem, but by governments in southern Africa, the communities that miners live in and their families. The burden has shifted unfairly from the mining industry to the state and the family.

What has been the mining industry’s role?

Silicosis is a preventable disease if proper controls are enforced. Australia has a large mining sector but there are no silicosis cases. Any case of silicosis is a failure of the mining bosses to control the dust in the mines. It may be expensive to control dust levels, but there is a technical solution available.

More recently mines have made strong efforts to reduce dust levels and if current dust controls are rigorously applied and adhered to, they may provide enough protection. We will have to watch and see how it develops.

But the problem lies with enforcement. The South African Department of Minerals has a shortage of inspectors to monitor dust levels at the mines. This needs highly skilled people. Mines are relied on to measure and report their own dust levels. In truth, a rigorous external body is needed to run checks. The inspectorate needs to be beefed up.

Are there adequate measures for compensation for miners who develop disease?

Miners who fall ill at a mine can go through a compensation process. But the challenge lies with the hundreds of thousands of ex-miners scattered across the southern African region.

A recent report, which is not yet published, was submitted to the South African National Department of Health. It handles the compensation process, highlights the problem. One of the main challenges is that facilities to examine potentially diseased ex-miners are few and far between.

There are vast areas in South Africa and the region where these clinics simply do not exist. So accessing the compensation system and getting paid out is impossible for most claimants.

In addition, the once-off payment they get is a disgrace. There are international standards that stipulate miners who can no longer work because they are suffering from an occupational disease should be paid enough to live a dignified existence. This is certainly not the case.